Summary: Obamacare mandates that you have insurance or pay a penalty. Now, physicians are refusing to take patients who have insurance? Is this counterintuitive? The new trend is that of the cash and carry physician. How will this affect the “affordable” and “accessible” care which Obamacare strives to achieve?
The Cash and Carry Physician Philosophy
Obamacare has had some bad side effects. In previous times, physicians were all too happy to sign up with health insurance networks to increase their business volume. The more networks they joined the more patients they saw and therefore the more profitable their practice became. As a strange twist of events due to Obamacare, Medicare cutbacks, increased claim denials, etc., a good number of physicians are switching to a cash and carry physician philosophy, refusing to take any type of insurance.
The Affordable Care Act, a.k.a. Obamacare requires all Americans with very few exceptions to carry health insurance coverage or face pretty steep penalties. One of the advantages of health insurance is having the price of services reduced due to “in network” or other re-pricing options. Another advantage of health insurance is only having to pay a copayment, having the claim filed, and paying any residual amounts owed at a later date. Finally, and most importantly, health insurance coverage greatly reduces the amount owed for major services like surgery or cancer treatments.
This being said, from a physician’s perspective, there is a lot of hassle with filing claims, reprocessing/appealing denied claims, collecting amounts owed after the patient leaves the facility, and the reductions in reimbursement especially with regard to Medicare. Many physicians are now taking a stand and refusing to take some or all insurance types and adopting a cash and carry physician philosophy. One of the benefits of this philosophy is a reduction in administrative expenses, in particular, billing/claims personnel may no longer be needed. The front desk duties are reduced in terms of the amount of data entry required.
Some physicians who have adopted this cash and carry physician philosophy are posting their prices on their website for the most common services and comparing them to what the patient would pay at other facilities such as hospitals.
According to an article from Forbes, “Will the Government Start Forcing Doctors to See Obamacare Patients”, several trends are beginning:
- CMS reported that 9,500 doctors who previously accepted Medicare patients refused to do so in 2012
- Doctors willing to accept new Medicare patients declined from 83% to 81%
- 33% of primary care physicians aren’t accepting new Medicaid patients
- Physicians are being reimbursed less for Obamacare exchange patients than non-Obamacare
There are rumblings in Congress to try to force physicians to accept Obamacare patients. Financial incentives may be dangled as a carrot or refusing to license within certain states those physicians who refuse to accept Obamacare patients. This could definitely get ugly and could exacerbate the already critical physician shortage. If this comes to pass, physicians will likely start retiring in droves rather than have the government dictate who they have to treat and what insurances they have to take. On the other end of the spectrum, there will likely be a diminish in the number of individuals wanting to enter the medical field.
Where do you stand on this issue? Do you think physicians should be able to deny services to those who have and wish to use insurance? Do you think the government should be able to dictate and control patient mix for individual physicians? How do you think the election will affect this issue? What happened to the accessibility aspect of the Affordable Care Act? Accessible for whom? If patients are forced to pay the bill in its entirety up front, is this really affordable? Will individuals opt not to have wellness exams and other services due to not having the upfront costs? Will Obamacare really reduce healthcare costs and improve quality?
About BHM Healthcare Solutions – www.bhmpc.com
BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including healthcare transformation assistance, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.
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